J Breast Cancer.  2016 Sep;19(3):324-329. 10.4048/jbc.2016.19.3.324.

Ductal Breast Carcinoma Metastatic to the Stomach Resembling Primary Linitis Plastica in a Male Patient

• Ricciuti B
• Leonardi G
• Ravaioli N
• De Giglio
• Brambilla
• Prosperi E
• Ribacchi F
• Meacci M
• Crinò L
• Maiettini
• Chiari R
• Metro G

• KMID: 2413958
• DOI: http://doi.org/10.4048/jbc.2016.19.3.324

Abstract

Breast cancer metastases to the gastrointestinal tract are very rare occurrences. Among the histological subtypes of breast cancer, invasive lobular carcinomas have a high capacity of metastasis to uncommon sites including the stomach. Conversely, there has not been sufficient evidence supporting the gastric metastasis of invasive ductal carcinoma. Herein, we report a unique case of metastatic ductal breast carcinoma mimicking primary linitis plastica in a male patient, particularly focusing on the clinical and pathological features of presentation. Moreover, we propose a immunohistochemical panel of selected antibodies including those for cytokeratin 20, cytokeratin 7, estrogen receptor, progesterone receptor, E-cadherin, gross cystic disease fluid protein 15, and GATA binding protein 3 for an accurate differential diagnosis.

Keyword

Biomarkers; Breast neoplasms; Human epidermal growth factor receptor 2; Linitis plastica; Neoplasm metastasis

MeSH Terms

Antibodies
Biomarkers
Breast Neoplasms*
Breast*
Cadherins
Carcinoma, Ductal
Carcinoma, Lobular
Carrier Proteins
Diagnosis, Differential
Estrogens
Gastrointestinal Tract
Humans
Keratin-20
Keratin-7
Linitis Plastica*
Male*
Neoplasm Metastasis
Receptors, Progesterone
Stomach*
Antibodies
Biomarkers
Cadherins
Carrier Proteins
Estrogens
Keratin-20
Keratin-7
Receptors, Progesterone

Figure

• 

  Figure 1 Pathologic findings of primary breast carcinoma. (A) Microphotograph showing invasive ductal carcinoma of the breast growing within a desmoplastic stroma (H&E stain, ×400). (B) Immunohistochemical stain showing positivity for estrogen receptor (90%) (×400). (C) Immunohistochemical stain showing absence of expression of progesterone receptor (×400). (D) Immunohistochemical stain showing negativity for human epidermal growth factor receptor 2 expression (1+) (×400). The aforementioned histologic features and the immunohistochemical expression pattern of the tumor were consistent with a diagnosis of invasive breast ductal carcinoma.

• 

  Figure 2 Pre- and postoperative positron emission tomography/computed tomography (PET/CT) finding. (A) Unenhanced CT and (B) Fusion PET/CT axial images showing no gastric fluorodeoxyglucose (FDG) uptake neither gastric wall thickening. (C, D) PET/CT showing the wall thickening of the gastric antrum (white arrow head) with a significant FDG uptake (black arrow head). (E) CT axial arterial and (F) venous phase, respectively at 35 and 80 seconds after intravenous iodinate contrast medium injection, showing the progression of the wall thickening, now involving the antrum and the body of the stomach, figuring out a linitis plastic (white arrow heads). (G, H) PET/CT axial images performed after the gastric resection showing no FDG uptake at the level of Roux-en-Y esophagojejunal anastomosis.

• 

  Figure 3 Pathologic findings of gastric recurrence. (A) microphotograph showing the stomach wall infiltrated by the neoplasm, arranged in tubular and solid pattern of growth (H&E stain, ×100). (B) Note the infiltration of tumor cells in the normal gastric mucosa, which have large vesicular nuclei with prominent nucleoli (H&E stain, ×200). (C) Immunohistochemical stain showing immunoreactivity for cytokeratin 7 (×100). (D) Immunohistochemical stain showing immunoreactivity for gross cystic disease fluid protein 15 (×100). (E) Immunohistochemical stain showing immunoreactivity for GATA binding protein 3 (GATA3) (×100). (F) Immunohistochemical stain showing positivity for human epidermal growth factor receptor 2 expression (×400). In the lacking of immunohistochemistry positivity to hormone receptors, the combined use of gross cystic disease fluid protein 15, GATA3 and cytokeratin 7 allowed for correct diagnosis of metastatic ductal breast cancer to the stomach.

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